Monday, November 07, 2011

Guidelines Emphasize Cardiac Rehab After Heart Attack, Bypass Surgery

New guidelines developed by the American College of Cardiology Foundation and the American Heart Association emphasize for the first time the importance of participating in a cardiac rehabilitation program after a heart attack or bypass surgery, and of diagnosing and treating depression in heart disease patients.

The guidelines recommend that patients with coronary heart disease and other vascular disease such as stroke and peripheral artery disease:

stop smoking and avoid exposure to tobacco smoke

get at least 30 minutes of exercise 5-7 days a week

reduce weight if overweight, obese, or have a large waist

get an annual flu shot

take low-dose aspirin daily unless a physician prescribes a higher dose or recommends against it because of medical contraindications

In response to evidence from recent clinical trials, the guidelines make several changes in the recommended use of medications that reduce the tendency for blood clotting (antiplatelet agents/anticoagulants).

New drugs that may be used instead of clopidogrel in combination with aspirin for patients receiving coronary stents, such as prasugrel or ticagrelor, now are included.

The importance of adequate dosages for statin therapy (to lower cholesterol) for all patients with known atherosclerotic vascular disease also is emphasized. Low-dose aspirin therapy (75-162 mg) continues to be recommended for patients with known heart disease.

The writing group deferred modifying recommendations on high blood pressure and high blood cholesterol levels because new guidelines are anticipated to be released in 2012 from panels of the National Heart, Lung and Blood Institute that work specifically on these issues.

The guidelines are published in Circulation: Journal of the American Heart Association and Journal of the American College of Cardiology.